Tag Archives: discharge planning

Aging Parents and Tough Love; You Can Do This!


toughlove

Adult children of aging parents often struggle when the time comes to step in and assist with decision-making. The moment you realize your roles have reversed and you need to provide your aging parent with the support and care they need versus what they want.  Sometimes this happens gradually; sometimes the hospital is asking where you want your mom or dad discharged to and you haven’t a clue what to say.

It’s not easy…

It’s not easy when you know in your heart that your aging parent needs more help. Their home is a mess and you detect the smell of urine or their doctor is indicating a move to assisted living or worse yet the nursing home, is in order. Of course, your aging parent will have nothing of it and you’re left holding the bag of worries.  It’s difficult to balance their safety and their wishes when the two don’t coincide. The denial runs deep and you want to scream at the top or your lungs. You beg; you plead but it all falls on deaf ears.

I’ve been there…

Last year about this time my dad was in ICU in acute renal failure. it was clear to me early on that discharging right back to home was not going to be a good choice {read about the dirty details here}  yet that’s all he talked about; going home. I knew in my heart that if he didn’t get some inpatient rehab { i.e. nursing home care} that he would be back in the hospital within 2 weeks, if not 2 hours. I also knew in my heart that he was going to say “thanks but no thanks” to the nursing home idea, which he did.

Presenting it with clarity and compassion…

I was brutally honest {choosing my words very carefully} with my dad about what was happening and very clear about why he needed to go to the nursing home for a while. This piece of the tough love equation is easier for me because of my background but, with all my years of experience and know how, this was truly bringing me to my knees and pushing my inner child buttons like you wouldn’t believe. But I stayed the course by remaining clear and compassionate. I told him I loved him, I knew he was scared but that he’s was going to have to trust me on this.

Tough love doesn’t always feel good…

I will never forget the day my dad was wheeled out of the ambulance and brought in to the nursing home. The look on his face brought tears to my eyes and I seriously wanted to run away. Instead I ran to the door he was coming in so he could hear my reassurance that he was going to be in and out of there before he knew it. To be honest with you, I wasn’t convinced that was true but he needed to hear those words. Even as I write this, there’s a knot in the pit of my stomach and I’m tearful.

Tough love sometimes feels good…

My dad did make it out of skilled rehab {the nursing home} and continues to live at home with the support of his grandson. By stepping in and making that decision to strongly influence {force} my dad to spend time in the nursing home, I made sure he got the care he needed to be as independent and self-sufficient as he can possibly be at this stage in his life. When he talks about being in the nursing home, he admits he didn’t like it one little bit but he also doesn’t express any resentment about the experience; this is all I ask for.

I want you to know this…

Tough love is an issue of setting boundaries with our aging parents and doing what we know is right for them. It’s not always easy but if done with clarity and compassion tough love can make the difference between your aging parent being in a position that puts them at risk versus them getting the care they need so you can both sleep at night…

 

RELATED ARTICLES AND RESOURCES

Clarity Session to Help You Help Your Aging Parent

Aging Parents: My Personal Story

Aging Parents: Hospital Discharges


Hospital discharge planning is the process of developing a plan post hospitalization for an individual to receive appropriate services {think home health, rehab or nursing home}. The hospital by law must identify, at an early stage of hospitalization, all patients who are likely to suffer adverse health consequences upon discharge. For our purpose, this identification begins at the time of admission when your parent presents their Medicare card. The nuts and bolts list of what is required of the discharge plan process is very lengthy {dare I say boring} but what you need to know is this:

  •  The doctor following your parent in the hospital is the one driving the discharge time frame. If your primary care physician is not following in the hospital they cannot write orders regarding your treatment or hospital discharge.
  • That physician is very aware of the Medicare A guidelines in terms of billing and believe it or not their hands may be tied. This all relates to diagnostic related groups which you can read more about here…
  • If your hospital says to you: “I’m sorry but we’ve assessed your mother and believe she does not need a discharge plan” you can have your physician request one.
  • A discharge planner is responsible for arranging the services your parent will need at the time of discharge. Your discharge planner may be referred to as a care manager, social worker or registered nurse.
  • You have the right to appeal your discharge and there are very specific steps in place to do this. Speak with your physician, discharge planner or patient advocate for specifics.
  • The hospital indication that it’s time for discharge does not mean mom is ready to live at home independently but that the condition she was admitted for is stabilized and her time under Medicare A has come to an end.
  • Your hospital discharge planner will provide you with a list of available services i.e. home health agencies, skilled nursing facilities and can provide you with education but cannot give an opinion or recommend a specific organization.
  • Be open and honest with your discharge planner. If your dad was struggling at home before this hospital admission, he will probably need additional help {either at home, rehab or nursing home, companion care} at the time of discharge.
  • In order to receive skilled Medicare A services following the hospital admission, your mom or dad needs to be in the acute care setting for a minimum of 3 DAYS! This means that if discharge to skilled rehab happens on the 2nd day your parent will not receive inpatient Medicare A coverage for their rehab. Be aware, ask questions and advocate!

A discharge planner’s job is a pressure cooker type job with high expectations and huge case loads. I recommend that within 48 -72 hours of your parent being admitted to the hospital {depending on the situation: if it looks like a short term stay move quicker} YOU ask to speak with your discharge planner. The RN on the floor or someone at the nurses’ station should be able to provide you with the name of your discharge planner and how to get in contact with that person.

I’m happy to answer any questions you may have! Leave a comment…